BILL NUMBER: AB 656	CHAPTERED  10/10/99

	CHAPTER   719
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 6, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 8, 1999
	PASSED THE SENATE   SEPTEMBER 3, 1999
	AMENDED IN SENATE   AUGUST 31, 1999
	AMENDED IN SENATE   AUGUST 18, 1999
	AMENDED IN SENATE   JULY 12, 1999
	AMENDED IN ASSEMBLY   APRIL 27, 1999
	AMENDED IN ASSEMBLY   APRIL 8, 1999

INTRODUCED BY   Assembly Member Scott

                        FEBRUARY 23, 1999

   An act to amend Sections 1337.3 and 1337.6 of, and to add Section
1338.2 to, the Health and Safety Code, relating to care facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 656, Scott.  Nurse assistants:  training programs.
   Existing law requires skilled nursing or intermediate care
facilities to adopt a training program for nurse assistants that
meets standards established by the State Department of Health
Services.  Under existing law, applicants for certification as a
certified nurse assistant are required to meet certain
qualifications, including completion of an approved training program.

   This bill would require the department to convene a work group of
specified composition to develop recommendations on ways to expand
the availability of both training programs and nurse assistants
available for hire in the state.  This bill would require those
recommendations to be submitted to the department by July 1, 2001.
   Existing law sets forth requirements for renewal of certificates
issued to certified nurse assistants.  Under existing law, a
certificate that is not renewed within 4 years after its expiration
may not be renewed except upon completion of a certification program
unless certain conditions are met.
   This bill would reduce that time period to 2 years and revise the
conditions for renewal of certificates.
   Existing law requires the department to maintain a list of
approved training programs for nurse assistant certification, and to
include certain information on the list.  Existing law also requires
the department to inspect a representative sample of the training
programs.
   This bill would add to the information that is required to be
included on the list of programs, and would require the department to
examine the passage rate for trainees from each program, and to
require each program to maintain an average 60% test score passage
rate, calculated over a 2-year period.
   Existing law specifies the content of approved training programs.

   This bill would revise the content and required hours for those
programs.  This bill would further require the Chancellor of the
California Community Colleges to provide the department with a
process for approval of college credit, and would require the
department to make that information available to training programs.
   This bill would incorporate additional changes in Section 1337.3
of the Health and Safety Code, proposed by AB 1160, to become
operative only if AB 1160 and this bill are both chaptered and become
effective January 1, 2000, and this bill is chaptered last.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Patient needs in long-term health care facilities have changed
dramatically in the last ten years with many patients requiring more
intensive medical care for shorter periods of time.
   (b) The nurse assistant training program has not been reviewed or
revised for more than ten years to address the changing needs of
patient care in today's long-term health care facilities.
   (c) There is currently a shortage of 10,000 certified nurse
assistants available for hire and an inadequate number of active
training centers in the state to respond to this need, especially in
rural areas.
  SEC. 2.  It is the intent of the Legislature that training center
requirements be revised to provide greater consistency among training
programs and greater access for individuals to receive college
credits.  It is the further intent of the Legislature that the State
Department of Health Services convene a work group to provide
recommendations to the department on addressing the availability of
qualified certified nurse assistants for hire in the state.
  SEC. 3.  Section 1337.3 of the Health and Safety Code is amended to
read:
   1337.3.  (a) The state department shall prepare and maintain a
list of approved training programs for nurse assistant certification.
  The list shall include training programs conducted by skilled
nursing or intermediate care facilities, as well as local agencies
and education programs.  In addition, the list shall include
information on whether a training center is currently training nurse
assistants, their competency test pass rates, and the number of nurse
assistants they have trained.  Clinical portions of the training
programs may be obtained as on-the-job training, supervised by a
qualified director of staff development or licensed nurse.
   (b) It shall be the duty of the state department to inspect a
representative sample of training programs.  The state department
shall protect consumers and students in any training program against
fraud, misrepresentation, or other practices that may result in
improper or excessive payment of funds paid for training programs.
In evaluating a training center's training program, the state
department shall examine each training center's trainees' competency
test passage rate, and require each program to maintain an average 60
percent test score passage rate to maintain its participation in the
program.  The average test score passage rate shall be calculated
over a two-year period.  If the state department determines that any
training program is not complying with regulations or is not meeting
the competency passage rate requirements, notice thereof in writing
shall be immediately given to the program.  If the program has not
been brought into compliance within a reasonable time, the program
may be removed from the approved list and notice thereof in writing
given to it.  Programs removed under this article shall be afforded
an opportunity to request reinstatement of program approval at any
time.  The state department's district offices shall inspect
facility-based centers as part of their annual survey.
   (c) Notwithstanding provisions of Section 1337.1, the approved
training program shall consist of at least the following:
   (1) A 16-hour orientation program to be given to newly employed
nurse assistants prior to providing direct patient care, and
consistent with federal training requirements for facilities
participating in the Medicare or medicaid programs.
   (2) A certification training program consisting of at least 60
classroom hours of training on basic nursing skills, patient safety
and rights, the social and psychological problems of patients, and
elder abuse recognition and reporting, as well as at least 100 hours
supervised and on-the-job training clinical practice.  The 100 hours
may consist of normal employment as a nurse assistant under the
supervision of either the director of staff development or a licensed
nurse.  The 60 classroom hours of training may be conducted within a
skilled nursing facility, an intermediate care facility, or an
educational institution.
   (d) The state department, in consultation with the State
Department of Education and other appropriate organizations, shall
develop criteria for approving training programs, that includes
program content for orientation, training, inservice and the
examination for testing knowledge and skills related to basic patient
care services and shall develop a plan that identifies and
encourages career ladder opportunities for certified nurse
assistants.  This group shall also recommend, and the department
shall adopt, regulation changes necessary to provide for patient care
when facilities utilize noncertified nurse assistants who are
performing direct patient care.  The requirements of this subdivision
shall be established by January 1, 1989.
   (e) A skilled nursing or intermediate care facility shall
determine the number of specific clinical hours within each module
identified by the state department required to meet the requirements
of subdivision (d), subject to subdivisions (b) and (c).  The
facility shall consider the specific hours recommended by the state
department when adopting the certification training program required
by this chapter.
   (f) This article shall not apply to a program conducted by any
church or denomination for the purpose of training the adherents of
the church or denomination in the care of the sick in accordance with
its religious tenets.
   (g) The Chancellor of the California Community Colleges shall
provide to the state department a standard process for approval of
college credit.  The state department shall make this information
available to all training programs in the state.
  SEC. 3.5.  Section 1337.3 of the Health and Safety Code is amended
to read:
   1337.3.  (a) The state department shall prepare and maintain a
list of approved training programs for nurse assistant certification.
  The list shall include training programs conducted by skilled
nursing or intermediate care facilities, as well as local agencies
and education programs.  In addition, the list shall include
information on whether a training center is currently training nurse
assistants, their competency test pass rates, and the number of nurse
assistants they have trained.  Clinical portions of the training
programs may be obtained as on-the-job training, supervised by a
qualified director of staff development or licensed nurse.
   (b) It shall be the duty of the state department to inspect a
representative sample of training programs.  The state department
shall protect consumers and students in any training program against
fraud, misrepresentation, or other practices that may result in
improper or excessive payment of funds paid for training programs.
In evaluating a training center's training program, the state
department shall examine each training center's trainees' competency
test passage rate, and require each program to maintain an average 60
percent test score passage rate to maintain its participation in the
program.  The average test score passage rate shall be calculated
over a two-year period.  If the state department determines that any
training program is not complying with regulations or is not meeting
the competency passage rate requirements, notice thereof in writing
shall be immediately given to the program.  If the program has not
been brought into compliance within a reasonable time, the program
may be removed from the approved list and notice thereof in writing
given to it.  Programs removed under this article shall be afforded
an opportunity to request reinstatement of program approval at any
time.  The state department's district offices shall inspect
facility-based centers as part of their annual survey.
   (c) Notwithstanding provisions of Section 1337.1, the approved
training program shall consist of at least the following:
   (1) A 16-hour orientation program to be given to newly employed
nurse assistants prior to providing direct patient care, and
consistent with federal training requirements for facilities
participating in the Medicare or medicaid programs.
   (2) (A) A certification training program consisting of at least
60 classroom hours of training on basic nursing skills, patient
safety and rights, the social and psychological problems of patients,
and elder abuse recognition and reporting pursuant to subdivision
(e) of Section 1337.1.  The 60 classroom hours of training may be
conducted within a skilled nursing facility, an intermediate care
facility, or an educational institution.
   (B) In addition to the 60 classroom hours of training required
under subparagraph (A), the certification program shall also consist
of 100 hours of supervised and on-the-job training clinical practice.
  The 100 hours may consist of normal employment as a nurse assistant
under the supervision of either the director of staff development or
a licensed nurse.  The 100 hours shall consist of at least four
hours of supervised training to address the special needs of persons
with developmental and mental disorders, including mental
retardation, Alzheimer's disease, cerebral palsy, epilepsy, dementia,
Parkinson's disease, and mental illness.
   (d) The state department, in consultation with the State
Department of Education and other appropriate organizations, shall
develop criteria for approving training programs, that includes
program content for orientation, training, inservice and the
examination for testing knowledge and skills related to basic patient
care services and shall develop a plan that identifies and
encourages career ladder opportunities for certified nurse
assistants.  This group shall also recommend, and the department
shall adopt, regulation changes necessary to provide for patient care
when facilities utilize noncertified nurse assistants who are
performing direct patient care.  The requirements of this subdivision
shall be established by January 1, 1989.  This subdivision shall
become inoperative on January 1, 2005.
   (e) (1) On or before January 1, 2003, the state department, in
consultation with the State Department of Education, the American Red
Cross, and other appropriate organizations, shall do the following:

   (A) Develop a standardized curriculum for approved training
programs for certified nurse assistants and criteria for approving
training programs, that includes program content for orientation,
training, in-service programs, and the examination for testing
knowledge and skills related to basic patient care services.
   (B) Review the current examination for approved training programs
for certified nurse assistants to ensure the accurate assessment of
whether a nurse assistant has obtained the required knowledge and
skills related to basic patient care services and that shall be
consistent with the standardized curriculum developed pursuant to
subparagraph (A).
   (C) Develop a plan that identifies and encourages career ladder
opportunities for certified nurse assistants, including the
application of on-the-job postcertification hours to educational
credits.
   (2) On or before January 1, 2004, the group established for
purposes of paragraph (1) shall recommend, and the department shall
adopt, regulation changes necessary to provide for the certification
training programs.
   (f) A skilled nursing or intermediate care facility shall
determine the number of specific clinical hours within each module
identified by the state department required to meet the requirements
of subdivision (d), subject to subdivisions (b) and (c).  The
facility shall consider the specific hours recommended by the state
department when adopting the certification training program required
by this chapter.
   (g) This article shall not apply to a program conducted by any
church or denomination for the purpose of training the adherents of
the church or denomination in the care of the sick in accordance with
its religious tenets.
   (h) The Chancellor of the California Community Colleges shall
provide to the state department a standard process for approval of
college credit.  The state department shall make this information
available to all training programs in the state.
  SEC. 4.  Section 1337.6 of the Health and Safety Code is amended to
read:
   1337.6.  (a) Certificates issued under this article shall be
renewed every two years and renewal shall be conditional upon the
occurrence of all of the following:
   (1) The certificate holder submitting documentation of completion
of 48 hours of in-service training every two years obtained through
an approved training program or taught by a director of staff
development for a licensed skilled nursing or intermediate care
facility that has been approved by the state department, or by
individuals or programs approved by the state department.  At least
12 of the 48 hours of in-service training shall be completed in each
of the two years.
   (2) The certificate holder obtaining a criminal record clearance.

   (b) Certificates issued under this article shall expire on the
certificate holder's birthday.  If the certificate is renewed more
than 30 days after its expiration, the certificate holder, as a
condition precedent to renewal, shall also pay the delinquency fee
prescribed by this article.
   (c) To renew an unexpired certificate, the certificate holder
shall, on or before the certificate expiration date, apply for
renewal on a form provided by the state department, pay the renewal
fee prescribed by this article, and submit documentation of the
required in-service training.
   (d) The state department shall give written notice to a
certificate holder 90 days in advance of the renewal date and, 90
days in advance of the expiration of the fourth year that a renewal
fee has not been paid, and shall give written notice informing the
certificate holder, in general terms, of the provisions of this
article.  Nonreceipt of the renewal notice does not relieve the
certificate holder of the obligation to make a timely renewal.
Failure to make a timely renewal shall result in expiration of the
certificate.
   (e) Except as otherwise provided in this article, an expired
certificate may be renewed at any time within two years after its
expiration on the filing of an application for renewal on a form
prescribed by the state department, and payment of the renewal fee in
effect on the date the application is filed, and documentation of
the required in-service education.
   Renewal under this article shall be effective on the date on which
the application is filed, on the date when the renewal fee is paid,
or on the date on which the delinquency fee is paid, whichever occurs
last.  If so renewed, the certificate shall continue in effect until
the date provided for in this article, when it shall expire if it is
not again renewed.
   (f) If a certified nurse assistant applies for renewal more than
two years after the expiration, the certified nurse assistant shall
complete an approved 75-hour competency evaluation training program
and competency evaluation program.  If the certified nurse assistant
demonstrates in writing to the state department's satisfaction why
the certified nurse assistant cannot pay the delinquency fee, then
the state department on a case-by-case basis shall consider waiving
the delinquency fee.  A suspended certificate is subject to
expiration and shall be renewed as provided in this article, but this
renewal does not entitle the certificate holder, while the
certificate remains suspended, and, until it is reinstated, to engage
in the certified activity, or in any other activity or conduct in
violation of the order or judgment by which the certificate was
suspended.
   (g) A revoked certificate is subject to expiration as provided in
this article, but it cannot be renewed.  If reinstatement of the
certificate is approved by the state department, the certificate
holder, as a condition precedent to reinstatement, shall pay a
reinstatement fee in an amount equal to the renewal fee in effect on
the date the application for reinstatement is filed, plus the
delinquency fee, if any, accrued at the time of its revocation.
   (h) Except as provided in subdivision (i), a certificate that is
not renewed within four years after its expiration cannot be renewed,
restored, reissued, or reinstated except upon completion of a
certification program unless deemed otherwise by the state department
if all of the following conditions are met:
   (1) No fact, circumstance, or condition exists that, if the
certificate was issued, would justify its revocation or suspension.
   (2) The person pays the application fee provided for by this
article.
   (3) The person takes and passes any examination that may be
required of an applicant for a new certificate at that time, that
shall be given by an approved provider of a certification training
program.
   (i) A certified nurse assistant whose certificate has expired
after two years may have his or her certificate renewed if he or she
pays a training application fee, completes 75 hours in an approved
competency evaluation training program, passes a competency test, and
obtains a criminal background clearance prior to the renewal.  The
department shall develop a training program for these previously
certified individuals.
   (j) Certificate holders shall notify the department within 60 days
of any change of address.  Any notice sent by the department shall
be effective if mailed to the current address filed with the
department.
   (k) Certificate holders that have been certified as both nurse
assistants pursuant to this article and home health aides pursuant to
Chapter 8 (commencing with Section 1725) of Division 2 shall renew
their certificates at the same time on one application.
  SEC. 5.  Section 1338.2 is added to the Health and Safety Code, to
read:
   1338.2.  (a) The state department shall convene a work group to
develop recommendations to the department on ways to expand the
availability of training programs and certified nurse assistants
available for hire in the state.  The work group shall investigate,
but not be limited to investigating, all of the following:
   (1) Work-based learning programs for students in the regional
occupational programs in the state.
   (2) Utilization of apprenticeships.
   (3) Promotional programs for training centers and certified nurse
assistant jobs.
   (4) Utilization of expanded data resources.
   (b) The recommendations required by subdivision (a) shall be
submitted by the work group to the state department on or before July
1, 2001.
   (c) The work group shall consist of, but not be limited to, all of
the following:
   (1) A representative from the State Department of Education.
   (2) Nurse-Assistant training center representatives.
   (3) A director of staff development for a long-term health care
facility.
   (4) A publisher of nurse assistant training and competency
curricula.
   (5) An industry representative.
   (6) A currently certified nurse assistant.
   (7) A consumer representative.
   (8) A labor union representative.
   (9) A representative of the American Red Cross.
   (10) The Chancellor of the California Community Colleges.
   (11) A representative from the Office of Statewide Health Planning
and Development.
   (12) A registered nurse and a licensed vocational nurse, both of
whom are currently providing long-term care nursing services.
  SEC. 6.  Section 3.5 of this bill incorporates amendments to
Section 1337.3 of the Health and Safety Code proposed by both this
bill and AB 1160.  It shall only become operative if (1) both bills
are enacted and become effective on or before January 1, 2000, (2)
each bill amends Section 1337.3 of the Health and Safety Code, and
(3) this bill is enacted after AB 1160, in which case Section 3 of
this bill shall not become operative.
